Product Proliferation under Rational Inattention: Application to Health Insurance

In markets with complicated products such as insurance, why do firms offer many products even when consumers appear to receive little benefit? We show that when consumers face information acquisition costs, firms may have an incentive to introduce many undifferentiated products. This allows firms to gain market share and increase markups. We document initial evidence consistent with the model using data from Medicare prescription drug insurance. Insurers that offer more duplicate or similar plans have higher-cost plans. These results suggest a role for policymakers to restrict product proliferation in markets with complicated products.

Assessment of the prospects for introducing drug insurance into military healthcare as part of project activities

It is shown that one of the priority areas of the social policy of the Russian Federation is the consideration of improving the drug supply, the rationale for the national drug policy, as well as the introduction of the drug reimbursement (insurance) system, as one of the key mechanisms to increase the affordability of drugs by partially or fully reimbursing their cost citizens when providing medical care on an outpatient basis. It was revealed that in the context of reforming the healthcare system, the specifics of the work of power ministries and departments are not sufficiently taken into account. In this regard, the features have been studied and an assessment has been given of the prospects for introducing drug insurance into military health care as part of project activities, as one of the mechanisms for implementing interagency cooperation in modern socio- economic conditions when reforming drug supply. It is reflected that the introduction of drug insurance mechanisms can increase the availability of drugs, have a positive effect on the health of the assigned contingents, and reduce the frequency and duration of hospitalizations. At the same time, the following were identified as the main prospects and systemic prerequisites for implementation: the need to create a reliable legal basis for the formation and subsequent development of a unified state system of drug supply, taking into account the specifics of military health; transition to a rational system of financing drug supply for the provision of medical care on an outpatient and inpatient basis as part of a project to develop a new model for the provision of primary health care and specialized medical care based on a unified medical and technological hospital base; prospective reduction of expenses for the supply of medical care in stationary conditions; optimal distribution of rights and responsibilities, ensuring coherence between health authorities; prevention of duplication, ensuring equal and guaranteed drug supply for citizens as part of the project to ensure the quality and accessibility of medical care to privileged contingents of the Ministry of Defense of the Russian Federation. A possible model of drug supply for contingents attached to military medical organizations is substantiated when providing medical care on an outpatient basis when introducing a drug insurance system at the state level. The following key elements of a grounded model are described: adjustment of drug supply management; clarification of the categories of assigned contingents; optimization of the order of dispensing of drugs; the formation of restrictive lists of drugs; optimization of financing.

Retirement Lock and Prescription Drug Insurance: Evidence from Medicare Part D

I examine whether lack of an individual market for prescription drug insurance causes individuals to delay retirement. Exploiting the 2006 introduction of Medicare Part D, which subsidized drug insurance for Americans over age 65, I use a triple-differences design that compares labor outcomes of individuals with retiree health insurance up to age 65 to those with insurance for life, before and after age 65, before and after 2006. I find that those with benefits only to age 65 decreased full-time work by 8.4 percentage points, of which 70 percent was due to transitions to part-time work. (JEL G22, H51, I13, I18, J14, J26)

Evaluation of polypharmacy in Japan using the national health insurance claims database in 2015-2017

Background There is growing awareness of polypharmacy as a global issue. Several countries have introduced policies to optimize multidrug prescriptions. In Japan, hospital prescription fee “F100” and outpatient prescription fee “F400” have been instituted to promote the correct use of drugs, the medical treatment fee is restricted when seven or more types of drugs are prescribed. However, non-polypharmacy patients who need multiple drugs are also comprehensively evaluated within the purview of the same drug insurance claim criteria. Thus, the current state of such policies is still unclear. This study identified the age group in which drug claims have changed based on drug insurance claim criteria and elucidated the relationship between policy interventions and multidrug prescriptions. Methods We analyzed F100 and F400 cases using open data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan from April 2015 to March 2017. These sources include a population of about 69 million patients. Moreover, the growth rate of the number of patients who were prescribed seven or more types of drugs was evaluated. Results F100 prescription claims decreased by − 12.7% (n = 3,239,070) in 2016 as compared to 2015 (n = 3,700,396), and the number of F400 prescription claims decreased by − 7.7% (n = 28,745,468) in 2016 as compared to 2015 (n = 31,142,484), for seven or more types of drugs. The drug insurance claim rate among people over the age of 65 was 74.2% to F100 and 77.9% to F400, and this age group represented the highest proportion among all age groups. Conclusions The rate of health insurance claims for multidrug prescriptions clearly decreased after the institution of policy interventions to optimize the use of seven or more types of drugs. The present study suggests that the prescription fee restriction could reduce the rate of multidrug prescriptions and consequent decreases the risk of adverse drug-related events in polypharmacy patients. Key messages Policy interventions related to the optimization of drug prescriptions encourage behavioral factors of healthcare providers. Polypharmacy treatment must be established through prescriptions information linkage between clinical practices and community.

Evaluation of Prescription Adaptation Following Changes to A Provincial Drug Insurance Formulary

On 1 December 2016, British Columbia’s (BC) provincial drug insurance program changed which medications in certain classes would benefit under the insurance program in an attempt to reduce expenditure. As part of the modernization, HMG-CoA reductase inhibitors (Statins), Angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), and dihydropyridine calcium channel blockers (CCB) were affected. Prescribers and pharmacists had six months to discuss the changes with patients, and change medications if deemed necessary. Purpose: To quantify the changes made to prescriptions and to adjust to the Modernized Reference Drug Program. Methods: A retrospective chart review was conducted at two clinics in Prince George, BC. Charts for patients that were prescribed any drugs in the affected classes were reviewed to determine if, and when, they had been changed, and by which health care professional. In December 2016, a clinical pharmacist, integrated within the study clinics, informed prescribers of the changes, and made patient-specific clinical notes within the charts. The notes described the changes and recommended alternative agents and appropriate dosing in order to assist the prescriber to have a conversation with the patient regarding the switch. Results: Out of 429 unique patients, 233 patients were prescribed a Statin, 229 patients an ACEI, 110 an ARB and, 83 a CCB. Sixty-five drug changes were indicated to reflect the modernization, and with guidance from a clinical pharmacist, nurse practitioners (NPs), and family physicians (FPs), 65% of these identified drugs were switched to reflect the modernization. Community pharmacists made no drug changes in the study sample, despite the prescriptive authority and compensation available to do so. Province-wide, approximately 21% to 33% of affected drugs were switched during the same time-frame. Direct collaboration between a clinical pharmacist, working alongside NPs and FPs, was more successful in optimizing these medications when compared to standard practice, or community pharmacists alone.